Stanley Feld M.D., FACP,MACE
The devil is in the details. Many of the Obama administrations sound bites are lies.
The Megyn Kelly interview of Ezekial Emanual on the Kelly File October 25th 2013 is a must watch video. It is worth 9 minutes of every American’s time.
The Obama administration rolled out one of the chief architects of Obamacare to provide disinformation about the pending success of Obamacare.
I have written about Ezekial Emanuel’s disinformation campaigns. His misinformation is based on incorrect facts leading to misguided conclusions.
This Megyn Kelly interview is a perfect example of President Obama’s disinformation campaign.
The interview starts with President Obama’s promise that Obamacare will let you save up to $2500 on insurance premiums and be able to keep your doctor and your insurance plan if you like them. Obamacare will bend the cost curve. It looks like Obamacare is going to bend the cost curve up not down.
Dr. Emanuel says it is not President Obama’s fault that people cannot keep the same doctor or healthcare plan. Corporations and the healthcare insurance industry changed their insurance rules for business reasons. Obamacare did not change the rules.
Obamacare forced the healthcare insurance industry to change its rules.
Is Dr. Emanual in denial or is he lying?
Dr. Emanuel contradicts himself immediately by saying it is unethical and immoral to sell healthcare insurance plans that do not cover bare minimum care coverage such as maternity care, preventive care (not defined), pregnancy, pediatric dental care and drug coverage.
It should be obvious that everyone does not need maternity care or pediatric dental care.
Ezekial Emanuel then continues with a rant about McDonald’s Minimed insurance coverage plans being immoral and unethical.
This is a point at which reality and being disingenuous gets buried in the weeds.
President Obama has allowed corporations to avoid penalties by using “minimal essential coverage” criteria. Dr. Emanuel certainly knows about and understands this nuance. The Obama administration has certainly not explained it to the public.
Dr. Emanuel also ignores the fact the President Obama’s gave waivers to 13,000 companies permitting them to continue to provide Minimed coverage until January 2014. It has now been extended until January 2015.
President Obama has modified minimal essential coverage criteria through CMS administrative regulations bypassing congress.
In August 2013 The Kaiser Foundation News published an article called “Why Health Law's 'Essential' Coverage Might Mean 'Bare Bones' “
“It came as a surprise to some that the Affordable Care Act seems to allow large employers to offer health insurance that pays for preventive care and not much else.”
“How can Ezekial Emanual brag about a law he praises for expanding coverage -- one that includes an "employer mandate" to offer "minimum essential coverage" -- allow companies to offer insurance that might not even cover hospitalization?
I will spend the rest of this blog explaining this nuance.
Dr. Emanuel misinforms the audience throughout the interview.
There has been no outright ban on these skinny plans -- even after the employer mandate kicks in in 2015.
Instead, large employers -- those with 50 or more full-time employees -- run the risk of fines (penalty) only if the coverage doesn't conform to ACA (Obamacare) rules.
“ The regulations published so far, however, seem to allow skinny plans with a penalty that many employers may choose to pay because it is less costly than offering fuller coverage.”
There are two fines in the health law for large employers. There is a $2,000 per employee fine for any company that does not offer "minimum essential coverage."
Most people do not know that the fine is only triggered when at least one employee enrolls in the health insurance exchange and receives subsidized coverage.
If none of the employees enroll and get subsidized coverage from the government, the corporation is not liable for the $2,000 per employee fine.
What is the definition of “minimum essential coverage”? It is not the same as "essential health benefits," that include maternity benefits and prescription drugs. Those essential health benefits vs. minimum essential coverage are benefits that must be included in plans sold to individuals or small employers.
Who suffers? The small businessman, and the individual buyer in the health insurance exchange will suffer the most.
Most large corporations are self- insured. A self-insured company provides dollar coverage for their employees’ illness. The company pays the bills minus the deductibles for each employee. The corporation is assuming the risk rather than the healthcare insurance company.
The insurance company does the administrative services just as they do for the federal government for Medicare, Medicaid and government worker insurance (Medicare Part C).
The self-insured corporation is the sponsor for the health insurance. A self-insured corporation passes one test necessary for “minimum essential coverage.” This avoids the $2,000 per employee penalty (fine).
If the company goes over the amount the company paid the previous year to cover employees’ illnesses, the corporations pays the difference in the following years administrative services fee to the healthcare insurance carrier.
The regulations are obscure, defining minimum essential coverage largely in terms of what it is not. Therein lies the loophole.
“As a result, many experts believe large employers can shield themselves from the $2,000 penalty by offering a plan that covers the health law's required preventive care, but still leaves workers vulnerable to thousands in bills if they're hospitalized.”
The young people working for minimum wage at McDonald don’t want to spend their money on full healthcare insurance. They believe they will not get sick. They cannot to buy insurance through the health insurance exchange.
They do not want to go on Medicaid. Many physicians view Medicaid as unacceptable insurance.
Government reimbursement is for Medicaid is extremely low. In some cases it is lower than the physician’s overhead to provide the care.
Many physicians do not take Medicaid patients. This results in long waits for appointments, a lack of access to timely care and in many cases rationing of care.
Medicaid is free to the needy. Nonetheless the government must pay the insurance industry for their administrative services.
According to Alden Bianchi, a Boston-based benefits and compensation lawyer. “
“Skinny coverage flunks the test, based on regulations that measure minimum value against "benchmark plans" in each state.”
The trick is the employer penalty is only $3,000 for each worker enrolling in subsidized exchange coverage. The fine is not imposed on the employer for all workers.
The fine will be much less than the fine for not offering a minimum essential coverage plan of $2,000 per employee if one employee buys subsidized coverage through the health insurance exchange.
Bianchi, who represents large employers said in an industry brief.
“The people who wrote the law intended to give companies a bare-bones option.”
"The ability to offer such plans is a result of conscious policy decisions by Congress, as implemented by the regulators."
I think he is wrong.
I think the Cato Institute’s Michael Cannon is right.
Cannon suspects the administration "had no idea what they were doing," as he wrote on the libertarian think tank's blog.
I think President Obama’s goal is to drive everyone into the health insurance exchanges and use the “public option.”
The health insurance exchanges’ non-subsidized options are in some cases double the previous price for healthcare insurance despite the claims of the Obama administration.
Obamacare is now backfiring on the President and his administration.
I apologize for not exposing the misinformation of each point Ezekial Emanual was sent out by the Obama administration to make on the Kelly File.
It is all disinformation and spin.
I felt it was important to explain the confusion created about the $2,000 and $3,000 dollar penalties attached to the mandates.
The corporate self-insured have figured out a way to get around the mandate and penalty. They also get around the mandate by hiring only part-time new employees who work less than 30 hours per week.
President Obama has bragged that new job creation is slowly improving. However, 77% of the new job creation is for part time employment.
If one puts it all together it spells hard times for economic growth and Obamacare.
I implore you to watch the video and hear disinformation one of President Obama’s architects is peddling.
The issue is becoming clear. Can the American people trust President Obama to tell them the real story?
My impression is that it is doubtful.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone
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